Many health care, correctional facility, and other workers are at increased risk of tuberculosis for reasons unrelated to their work. Most people spend more time in the community than at work. In general, low-income individuals, members of racial and ethnic minorities, immigrants from developing countries, and people living in low-income neighborhoods are at higher risk of community-acquired tuberculosis infection and active tuberculosis. This does not mean that the risk of workplace transmission of tuberculosis can be disregarded for workers with these demographic risk factors. It does mean, however, that workplace surveillance programs need to consider the likelihood of community exposure in assessing the results of tuberculin skin tests.
Historically, health care workers were at higher risk from tuberculosis than others in the community. Since then, effective treatment has drastically cut tuberculosis case rates and consequently reduced health care workers’ occupational risk of tuberculosis. Lower community case rates also mean that prison, jail, homeless shelter, and other workers are less likely to be exposed to tuberculosis than in the past.
Still, tuberculosis remains a threat, particularly when the disease is unsuspected and undiagnosed and when infection control measures are neglected. Other risk factors for health care, correctional, and other workers include work that involves direct contact with people who have infectious tuberculosis and work in communities with high prevalence of the disease.